Skip to main content
SpringerLink
Log in

Experimental microendoscopic photoablative laser goniotomy as a surgical model for the treatment of dysgenetic glaucoma

  • Clinical Investigation
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

• Purpose: The aim of this study was to investigate the feasibility of photoablative Er:YAG laser goniotomy under microendoscopic control in a surgical cloudy corneal model of primary infantile glaucoma. • Methods: Pectinate ligaments of 12 freshly enucleated cadaver porcine eyes were treated by ab interno single-pulse (5 mJ, 200 μs) Er:YAG laser (2.94 μm) photoablation. Through a clear corneal incision near the limbus an ophthalmic microendoscope (18 and 20 gauge) was inserted into the anterior chamber. Internal structures were observed and photoablative laser goniotomy was conducted under video guidance. Following treatment all eyes were prepared for light and scanning electron microscopy. • Results: Anterior chamber angle structures and tissue photoablation were clearly visualized on the videoscreen using ophthalmic microendoscopy. Energy settings of 5 mJ per pulse proved to be sufficient for reproducible photoablation of pectinate ligaments, accompanied by the root of the iris falling back and exposing trabecular meshwork. This was confirmed histopathologically. Scatter thermal damage was less than 30 μm. • Conclusion: This new therapeutic modality, which combines endoscopic visualization of the internal structures with photoablative laser goniotomy, can be effective in the management of dysgenetic glaucoma in the presence of a cloudy cornea. High reproducibility of contact laser photoablation enabled sufficient control of incision depth and was not accompanied by inadvertent tissue damage to adjacent intraocular structures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen I, Burian HM, Braley AE (1955) A new concept of the development of the anterior chamber angle. Its relationship to developmental glaucoma and other structural abnormalities. Arch Ophthalmol 53:783–798

    Google Scholar 

  2. Allen I, Burian HM, Braley AE (1955) The anterior bordering of Schwalbe and pectinate ligament. Arch Ophthalmol 53:799–806

    Google Scholar 

  3. Anderson DR (1981) The development of the trabecular meshwork and its abnormality in primary infantile glaucoma. Trans Am Ophthalmol Soc 79:458–485

    Google Scholar 

  4. Barkan O (1938) Technique of goniotomy. Arch Ophthalmol 19:217–221

    Google Scholar 

  5. Barkan O (1942) Operation for congenital glaucoma. Am J Ophthalmol 22:552–568

    Google Scholar 

  6. Barkan O (1955) Pathogenesis of congenital glaucoma. Gonioscopic and anatomic observation of the angle of the anterior chamber in the normal eye and congenital glaucoma. Am J Ophthalmol 41:1–11

    Google Scholar 

  7. Deluise VP, Anderson DR (1983) Primary infantile glaucoma (congenital glaucoma). Surv Ophthalmol 28:1–19

    Google Scholar 

  8. Dickens CJ, Hoskins HD Jr (1989) Epidemiology and pathophysiology of congenital glaucoma. In: Rich R, et al. (eds) The glaucomas, vol 2. Mosby, St Louis

    Google Scholar 

  9. Duke-Elder S (1969) Congenital deformities. (System of ophthalmology, vol II, pt 2) Mosby, St Louis, pp 548–565

    Google Scholar 

  10. Ellis OU (1948) The etiology, symptomatology, and treatment of juvenile glaucoma. Am J Ophthalmol 31:1589–1596

    Google Scholar 

  11. Fankhauser F, Zypen E van der, Kwasniewska S (1985) The effect of thermal mode Nd:YAG laser radiation on vessels and ocular tissues. Ophthalmology 92:419–426

    Google Scholar 

  12. Hill RA, Baerfelt G, Ozler SA, Pickford M (1991) Laser trabecular ablation. Lasers Surg Med 11:341–346

    Google Scholar 

  13. Hill RA, Sten D, Lesiecki ML, Hsia J, Berns MW (1993) Effects of pulse on erbium: YAG laser photothermal trabecular ablation. Lasers Surg Med 13:440–446

    Google Scholar 

  14. Joos KM, Wallace LM, Folberg R (1993) Experimental endoscopic goniotomy. Ophthalmology 100:1066–1070

    Google Scholar 

  15. Kolker AE, Hetherington J (1976) Diagnosis and therapy of glaucoma. Mosby, St Louis, 276–321

    Google Scholar 

  16. Kupfer C, Kaiser-Kupfer MI (1979) Observations on the development of the anterior chamber angle with reference to the pathogenesis of congenital glaucomas. Am J Opthalmol 88:424–426

    Google Scholar 

  17. Latina MA, Drobrogowski M, March WF, Birngruber R (1990) Laser sclerostomy by pulsed dye laser and goniolens. Arch Ophthalmol 108:1745–1750

    Google Scholar 

  18. Lee WR, Dutton GN, Cameron SA (1988) Short-pulsed neodymium-YAG laser trabeculotomy. Invest Ophthalmol Vis Sci 29:1698–1707

    Google Scholar 

  19. Litinski SM, Shaffer RN, Hetherington J, Hoskins HD (1971) Operative complications in goniotomy. Ophthalmol 83:78–89

    Google Scholar 

  20. Mann I (1957) Developmental abnormalities of the eye. Lippincott, Philadelphia

    Google Scholar 

  21. Marshall J (1988) Lasers in ophthalmology: the basic principles. Eye 2 [Suppl]:98–112

    Google Scholar 

  22. McPherson SD Jr, Berry DP (1983) Goniotomy versus external trabeculotomy for developmental glaucoma. Am J Ophthalmol 95:427–431

    Google Scholar 

  23. Melamed S, Pei J, Puliafito CA, Epstein DL (1985) Q-switched neodymium:YAG laser trabeculopuncture in monkeys. Arch Ophthalmol 103:129–133

    Google Scholar 

  24. Melamed S, Latina MA, Epstein DL (1987) Neodymium:YAG laser trabeculopuncture in juvenile open-angle glaucoma. Ophthalmology 94:163–170

    Google Scholar 

  25. Miller SJH (1962) Genetic aspects for glaucoma. Trans Ophthalmol Soc UK 81:425–434

    Google Scholar 

  26. Moller PM (1977) Goniotomy and congenital glaucoma. Acta Ophthalmol 55:436–442

    Google Scholar 

  27. Oram O, Gross RL, Severin TD, Orengo-Nania S, Feldman RM (1995) Gonioscopic ab interno Nd:YLF laser sclerostomy in human cadaver eyes. Ophthalmic Surg 26:136–139

    Google Scholar 

  28. Özler SA, Hill RA, Baervelt G, Andrews JJ, Berns MW (1991) Infrared laser sclerostomies. Invest Ophthalmol Vis Sci 32:58–63

    Google Scholar 

  29. Peyman GA, Badaro RM, Khoobehi B (1989) Corneal ablation in rabbits using an infrared (2.9 μm) erbium:YAG laser on ocular structures. Ophthalmology 96:1160–1170

    Google Scholar 

  30. Thorpe HE (1934) Ocular endoscope. An instrument for the removal of intravitreous non-magnetic foreign bodies. Trans Am Acad Ophthalmol Otolaryngol 39:422–424

    Google Scholar 

  31. Troncoso MU, Castroviejo R (1936) Microanatomy of the eye with the slitlamp microscope. Comparative study of the angle of the anterior chamber in living and sectioned eyes of mammalia. Am J Ophthalmol 19:481–492

    Google Scholar 

  32. Uram M (1992) Ophthalmic laser microendoscope ciliary process ablation in the management of neovascular glaucoma. Ophthalmol 99:1823–1828

    Google Scholar 

  33. Uram M (1992) Ophthalmic laser microendoscope endophotocoagulation. Ophthalmology 99:1829–1832

    Google Scholar 

  34. Worst JGF (1966) The pathogenesis of congenital glaucoma. Royal van Gorcum, Assen, Netherlands/Thoms, Springfield, Ill.

    Google Scholar 

  35. Zypen E van der, Bebie H, Fankhauser F (1979) Morphological studies about the efficiency of laser beams upon the structures of the angle of the anterior chamber. Int Ophthalmol 1:109–122

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Eye Hospital of Cologne, Joseph-Stelzmannstrasse 9, D-50931, Cologne, Germany

    Philipp C. Jacobi, Thomas S. Dietlein & Günter K. Krieglstein

Authors
  1. Philipp C. Jacobi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas S. Dietlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Günter K. Krieglstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacobi, P.C., Dietlein, T.S. & Krieglstein, G.K. Experimental microendoscopic photoablative laser goniotomy as a surgical model for the treatment of dysgenetic glaucoma. Graefe's Arch Clin Exp Ophthalmol 234, 670–676 (1996). https://doi.org/10.1007/BF00292352

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00292352

Keywords

Search

Navigation